“Method For Identifying And Initiating Reversible Subrogation Claims” in Patent Application Approval Process (USPTO 20240112268): Patent Application

2024 APR 24 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A patent application by the inventor TIDBALL, Christopher (Cocoa, FL, US), filed on September 29, 2023, was made available online on April 4, 2024, according to news reporting originating from Washington, D.C., by NewsRx correspondents.

This patent application has not been assigned to a company or institution.

The following quote was obtained by the news editors from the background information supplied by the inventors: “When an insured person suffers a covered loss, an insurer may pay costs to the insured person and pursue subrogation from another party involved in the loss. For example, if an insured vehicle is involved in a collision and suffers a loss, the insurer may compensate the vehicle owner, i.e., insured, according to an insurance agreement. If, for example, the vehicle owner was not at fault in the collision, the insurer may pursue damages from another party, such as the insurer of the party who was at fault in the collision. An insurance agreement may include an obligation of the insured to assign the insured’s claim against a party at fault to the insurer, who may then collect on the claim on the insured’s behalf, i.e., subrogation. For example, if an insured’s car is destroyed in an auto accident caused by a third-party, the insured’s insurance company may pay the insured for the value of the car, and separately seek to recover the amount paid from the third-party’s insurance company or the third-party if uninsured.

“Analytics and algorithms have been developed to identify subrogation cases, which is often all that is needed, particularly for claims of low complexity. However, subrogation payments are sometimes made in situations where the payment was not actually owed according to statutes in individual jurisdictions. These improper payments may be reversed through legal means, but they are often never identified, so the improper payments are never reversed. For example, a van owned by a plumbing or construction company in New York rear-ends a car. The car owner’s insurance carrier pays the injured party in the car personal injury protection and then subrogates the claim to the plumbing company’s insurance carrier because the gross vehicle weight (GVW) is over 6,500 pounds per a tag check. However, a further check of the claim discovers that the unladen weight of the vehicle was only 5,200 pounds. According to current New York statutes, when vehicles involved in an accident are “covered,” they cannot sue each other for losses covered or that should be covered by personal injury protection, except when one of the vehicles involved in the accident weighs more than 6,500 pounds. Upon discovering that the van weights less than the 6,500-pound limit, such a claim would have been improperly paid and could be recoverable by the plumbing company’s insurance carrier (i.e., from the car owner’s insurance carrier).

“A primary challenge to identifying and initiating the subrogation payment reversal is analyzing a large amount of data to find subrogation payments that may be candidates for reversal. A further challenge lies in the broad range of statutes in each jurisdiction that govern subrogation payments, and their ever-changing nature.

“Accordingly, systems and methods to properly evaluate subrogated claims based on the relevant statutes, and recover claims paid based on incorrectly assigned fault are desirable.”

In addition to the background information obtained for this patent application, NewsRx journalists also obtained the inventor’s summary information for this patent application: “The present disclosure relates to efficient and cost-effective systems and computational methods for identifying and initiating the reversal of improper subrogation payments. Such systems and methods may be implemented on a computer system and may involve data transmitted over the internet, including cloud technologies or servers. Once reversible subrogation candidates are identified, a process to reverse the subrogation payment may be initiated.

“Accordingly, the present disclosure provides a method for identifying reversible subrogation claims. The method generally comprises receiving a list of subrogation demands, wherein the list includes at least one subrogation demand for an insurance claim; determining, by analysis of the insurance claim, a type of the insurance claim and a jurisdiction of the insurance claim; determining a subrogation rule based on the type of the insurance claim and the jurisdiction of the insurance claim; determining if the subrogation demand has been fulfilled; and providing an indication of a proper or improper subrogation demand, or fulfillment thereof, based on an analysis of the subrogation rule.

“When the subrogation demand was fulfilled and is improper, the method may further generate a recommendation to initiate recovery of the insurance claim and optionally, may initiate recovery of the insurance claim.

“The insurance claim may comprise any of a claim against one or more of a health insurance, a worker compensation insurance, a liability insurance, a homeowner’s insurance, a property casualty insurance, a motorized vehicle insurance, or a disability care insurance.

“The methods may be implemented as software executable by a processor. Moreover, the software may be provided as part of a system, such as a system comprising a server having a processor, a non-transitory computer-readable storage medium, and instructions stored on the non-transitory computer-readable storage medium for execution of the method by the processor.

“Abbreviations and Definitions

“Unless otherwise defined, all terms used herein, inclusive of technical and scientific terms, have a meaning as commonly understood by one of ordinary skill in an art to which this disclosure belongs. As such, terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in a context of a relevant art and should not be interpreted in an idealized or overly formal sense unless expressly so defined herein.

“The term “claim” in relation to an insurance policy should be understood to mean notice to an insurer that under the terms of a policy, a loss may be covered. Claims are typically received directly from the insured or from a representative of the insurance company (e.g., an insurance agent).

“Subrogation is an equitable doctrine that allows one party to replace another party when it comes to a legal right. The term “subrogation,” as used herein, may be understood to mean the substitution of one person or group by another in respect of a debt or insurance claim, accompanied by the transfer of any associated rights and duties.

“As used herein, “personal injury protection” or “PIP” refers to no-fault insurance, which helps cover expenses like medical bills, lost wages, funeral costs, etc. after a car accident, no matter who is at fault. Personal injury protection insurance generally does not cover property damage, the other drivers’ injuries in a collision, injuries from an accident while committing a crime, or injuries in an accident while the driver received payment for driving.

“Note that various terminology used herein may imply direct or indirect, full or partial, temporary or permanent, action or inaction. For example, when an element is referred to as being “on,” “connected,” or “coupled” to another element, then the element may be directly on, connected, or coupled to the other element or intervening elements may be present, including indirect or direct variants. In contrast, when an element is referred to as being “directly connected” or “directly coupled” to another element, there may be no intervening elements present.

“Furthermore, when this disclosure states that something is “based on” something else, then such statement refers to a basis which may be inclusive of one or more other things as well. In other words, unless expressly indicated otherwise, as used herein “based on” inclusively means “based at least in part on” or “based at least partially on.”

“As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items. Likewise, as used in the following detailed description, the term “or” is intended to mean an inclusive “or” rather than an exclusive “or.” That is, unless specified otherwise, or clear from context, “X employs A or B” is intended to mean any of the natural inclusive permutations. Thus, if X employs A; X employs B; or X employs both A and B, then “X employs A or B” is satisfied under any of the foregoing instances.

“The terminology used herein is for the purpose of describing particular examples only and is not intended to be limiting. As used herein, the singular forms “a,” “an,” and “the” may be intended to include the plural forms as well, unless the context clearly indicates otherwise. As example, “a” subrogation rule may comprise one or more subrogation rules, “an” insurance claim or “the” subrogation demand may comprise one or more insurance claims or subrogation demands, respectively, and “a” module may comprise one or more modules, and the like.

“The terms “comprises,” “comprising,” “including,” “having,” and “characterized by,” may be inclusive and therefore specify the presence of stated features, elements, steps, integers, operations, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. Although these open-ended terms may be to be understood as a non-restrictive term used to describe and claim various aspects set forth herein, in certain aspects, the term may alternatively be understood to instead be a more limiting and restrictive term, such as “consisting of” or “consisting essentially of.” Thus, for any given embodiment reciting components, elements, features, integers, operations, and/or process steps, described herein also specifically includes embodiments consisting of, or consisting essentially of, such recited components, elements, features, integers, operations, and/or process steps. In the case of “consisting of” the alternative embodiment excludes any additional components, elements, features, integers, operations, and/or process steps, while in the case of “consisting essentially of,” any additional components, elements, features, integers, operations, and/or process steps that materially affect the basic and novel characteristics may be excluded from such an embodiment, but any components, elements, features, integers, operations, and/or process steps that do not materially affect the basic and novel characteristics may be included in the embodiment.

“Any method steps, processes, and operations described herein may not be construed as necessarily requiring their performance in the particular order discussed or illustrated, unless specifically identified as an order of performance. It is also to be understood that additional or alternative steps may be employed, unless otherwise indicated.

“In addition, features described with respect to certain example embodiments may be combined in or with various other example embodiments in any permutational or combinatory manner. Different aspects or elements of example embodiments, as disclosed herein, may be combined in a similar manner. The term “combination,” “combinatory,” or “combinations thereof” as used herein refers to all permutations and combinations of the listed items preceding the term. For example, “A, B, C, or combinations thereof” is intended to include at least one of: A, B, C, AB, AC, BC, or ABC, and if order is important in a particular context, also BA, CA, CB, CBA, BCA, ACB, BAC, or CAB. Continuing with this example, expressly included may be combinations that contain repeats of one or more item or term, such as BB, AAA, AB, BBC, AAABCCCC, CBBAAA, CABABB, and so forth. The skilled artisan will understand that typically there is no limit on the number of items or terms in any combination, unless otherwise apparent from the context.

“Aspects of the present disclosure may be described herein with reference to flowchart illustrations and/or block diagrams of methods, apparatus (systems), and computer program products according to embodiments of the disclosure. It will be understood that each block of the flowchart illustrations and/or block diagrams, and combinations of blocks in the flowchart illustrations and/or block diagrams, may be implemented by computer readable program instructions. The various illustrative logical blocks, modules, circuits, and algorithm steps described in connection with the embodiments disclosed herein may be implemented as electronic hardware, computer software, or combinations of both. To clearly illustrate this interchangeability of hardware and software, various illustrative components, blocks, modules, circuits, and steps have been described above generally in terms of their functionality. Whether such functionality is implemented as hardware or software depends upon the particular application and design constraints imposed on the overall system. Skilled artisans may implement the described functionality in varying ways for each particular application, but such implementation decisions should not be interpreted as causing a departure from the scope of the present disclosure.”

There is additional summary information. Please visit full patent to read further.”

The claims supplied by the inventors are:

“1. A computer-implemented method of identifying reversible subrogation claims, the method comprising, via one or more processors, servers, and/or associated transceivers: receiving electronic data comprising a list including at least one subrogation demand for which a settlement payment has been made, each subrogation demand in the list being for an insurance claim, determining, by analysis of the insurance claim of each of the subrogation demands in the list, a type of the insurance claim and a jurisdiction of the insurance claim, determining, by accessing data stored on a database, a relevant subrogation rule for the insurance claim of each of the subrogation demands in the list based on the type of the insurance claim and the jurisdiction of the insurance claim, wherein the data stored on the database comprises jurisdictional statutes for subrogation of insurance claims, determining if each of the subrogation demands in the list was proper or improper based on an analysis of the relevant subrogation rule, and outputting, for each of the subrogation demands in the list, an indication that the subrogation demand was proper or improper based on the analysis of the relevant subrogation rule.

“2. The method of claim 1, comprising: storing, at the data store of the database, one or more subrogation rules; and updating the data store based on changes to the one or more subrogation rules.

“3. The method of claim 1, wherein the type of the insurance claim comprises a claim against one or more of health insurance, worker compensation insurance, liability insurance, homeowner’s insurance, travel insurance, property and casualty insurance, property insurance, motorized vehicle insurance, or disability care insurance.

“4. The method of claim 1, wherein the list includes, for each subrogation demand, subrogation demand information comprising a subrogee identity, the type of the insurance claim, the jurisdiction of the insurance claim, a loss amount, and a settlement payment amount.

“5. The method of claim 4, wherein the method further comprises, for at least one of the subrogation demands indicated to be improper and having been fulfilled: automatically initiating recovery of all or a portion of the settlement payment amount of the subrogation demand from the subrogee.

“6. The method of claim 1, wherein the list includes at least one subrogation demand that has not been fulfilled by a third party, and upon determining the type of insurance claim is not a personal injury protection claim and the subrogation demand is proper, the method comprises: automatically initiating recovery of all or a portion of a payment amount of the insurance claim from the third party.

“7. The method of claim 4, wherein the subrogation demand is determined to be improper if the insurance claim is a personal injury protection claim for a commercial vehicle having an unladen gross vehicle weight below a weight specified by the subrogation rule, wherein the method further comprises: generating a recommendation to initiate recovery of the settlement payment amount of the subrogation demand from the subrogee.

“8. The method of claim 4, wherein the subrogation demand is determined to be improper if the insurance claim is a personal injury protection claim for a multiple vehicle event involving a motorcycle and the subrogation demand should have been prorated, wherein the method further comprises: generating a recommendation to initiate recovery of at least a portion of the settlement payment amount of the subrogation demand from the subrogee.

“9. The method of claim 4, wherein the subrogation demand is determined to be improper if the insurance claim is not a personal injury protection claim but involved multiple tortfeasors and the insurance claim does not render voluntary payments non-recoverable, wherein the method further comprises: generating a recommendation to initiate recovery of at least a portion of the settlement payment amount of the subrogation demand from the subrogee.

“10. The method of claim 1, wherein the subrogation demand is determined to be improper if the insurance claim is not a personal injury protection claim and was issued by a member of Arbitration Forums, wherein the method further comprises: generating a recommendation to file for arbitration with Arbitration Forums.

“11. The method of claim 1, wherein the subrogation demand is determined to be improper if the insurance claim is not a personal injury protection claim and was not issued by a member of Arbitration Forums, wherein the method further comprises: generating a recommendation to initiate a litigation for recovery of a settlement payment of the subrogation demand.

“12. A computer-implemented method of identifying reversible subrogation claims, the method comprising, via one or more processors, servers, and/or associated transceivers: receiving electronic data comprising a list of subrogation demands comprising at least one subrogation demand for an insurance claim for which a settlement payment has been made, determining, by analysis of the insurance claim of each of the subrogation demands in the list, a type of the insurance claim and a jurisdiction of the insurance claim, determining, by accessing data stored on a database, a relevant subrogation rule for the insurance claim of each of the subrogation demands in the list based on the type of the insurance claim and the jurisdiction of the insurance claim, wherein the data stored on the database comprises jurisdictional statutes for subrogation of insurance claims, determining if each of the subrogation demand was proper or improper based on an analysis of the relevant subrogation rule for the insurance claim of each of the subrogation demands in the list; and outputting, for each of the subrogation demands in the list, an indication that the subrogation demand was proper or improper based on the analysis of the relevant subrogation rule, wherein the subrogation demand is determined to be improper if the insurance claim comprises: (a) a personal injury protection claim for a commercial vehicle having an unladen gross vehicle weight below a weight specified by the subrogation rule, wherein the method further comprises: generating a recommendation to initiate recovery of the settlement payment of the subrogation demand, (b) a personal injury protection claim for a multiple vehicle event involving a motorcycle and the subrogation demand should have been prorated, wherein the method further comprises: generating a recommendation to initiate recovery of at least a portion of the settlement payment of the subrogation demand, © not a personal injury protection claim but involved multiple tortfeasors and the insurance claim does not render voluntary payments non-recoverable, wherein the method further comprises: generating a recommendation to initiate recovery of at least a portion of the settlement payment of the subrogation demand, (d) not a personal injury protection claim and was issued by a member of Arbitration Forums, wherein the method further comprises: generating a recommendation to file for arbitration with Arbitration Forums, or (e) not a personal injury protection claim and was not issued by a member of Arbitration Forums, wherein the method further comprises: generating a recommendation to initiate a litigation for recovery of the subrogation demand.

“13. The method of claim 12, wherein the list of subrogation demands includes, for each subrogation demand, a subrogee identity, the type of insurance claim, the jurisdiction of the insurance claim, a loss amount, and a settlement payment amount.

“14. The method of claim 13, wherein the method further comprises, for at least one of the subrogation demands indicated to be improper: automatically initiating recovery of all or a portion of the settlement payment amount of the subrogation demand from the subrogee.

“15. The method of claim 12, wherein the list of subrogation demands comprises at least one subrogation demand that has not been fulfilled by a third party, and upon determining the type of insurance claim is not a personal injury protection claim and the unfulfilled subrogation demand is proper, the method comprises: generating a recommendation to pursue proactive subrogation from the third party for the insurance claim of the at least one subrogation demand that has not been fulfilled.

“16. The method of claim 12, comprising: storing, at the data store of the database, one or more subrogation rules; and updating the data store based on changes to the one or more subrogation rules.

“17. A system for identifying and initiating reversible subrogation claims, the system comprising: a processor; and a memory storing computer-readable instructions that, when executed by the processor, cause the processor to trigger execution of a reversible subrogation assistant, wherein the reversible subrogation assistant comprises: an input module configured to receive a list of subrogation demands, wherein the list comprises at least one subrogation demand that has been fulfilled, and determine, by analysis of the at least one subrogation demand, a type of insurance claim of the subrogation demand, and a jurisdiction of the insurance claim; a rules module configured to access a database comprising jurisdictional statutes for subrogation of insurance claims and determine a relevant subrogation rule based on the type of the insurance claim and the jurisdiction of the insurance claim; and a validation module configured to determine if the subrogation demand is proper or improper based on an analysis of the relevant subrogation rule.

“18. The system of claim 18, comprising a reversal module configured to automatically initiate recovery of all or a portion of a settlement payment for each subrogation demand determined to be improper.”

There are additional claims. Please visit full patent to read further.

URL and more information on this patent application, see: TIDBALL, Christopher. Method For Identifying And Initiating Reversible Subrogation Claims. U.S. Patent Application Number 20240112268, filed September 29, 2023 and posted April 4, 2024. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(20240112268)&db=US-PGPUB&type=ids

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